Handoff Practices in Undergraduate Medical Education
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
Growing data demonstrate that inaccuracies are prevalent in current handoff practices, and that these inaccuracies contribute to medical errors. In response, the Accreditation Council for Graduate Medical Education (ACGME) now requires residency programs to monitor and assess resident competence in handoff communication. Given these changes, undergraduate medical education programs must adapt to these patient safety concerns.
To obtain up-to-date information regarding educational practices for medical students, the authors conducted a national survey of Clerkship Directors in Internal Medicine (CDIM) members.
DESIGN AND PARTICIPANTS
In June 2012, CDIM surveyed its institutional members, representing 121 of 143 Departments of Medicine in the U.S. and Canada. The section on handoffs included 12 questions designed to define the handoff education and practices of third year clerkship and fourth year sub-internship students.
Ninety-nine institutional CDIM members responded (82 %). The minority (15 %) reported a structured handoff curriculum provided during the internal medicine (IM) core clerkship, and only 37 % reported a structured handoff curriculum during the IM sub-internship. Sixty-six percent stated that third year students do not perform handoff activities. However, most respondents (93 %) reported that fourth year sub-internship students perform patient handoff activities. Only twenty-six (26 %) institutional educators in CDIM believe their current handoff curriculum is adequate.
Despite the growing literature linking poor handoffs to adverse events, few medical students are taught this competency during medical school. The common practice of allowing untrained sub-interns to perform handoffs as part of a required clerkship raises safety concerns. Evidence-based education programs are needed for handoff training.
- Kohn L, Corrigan J, Donaldson MS. To err is human: Building a safer health care system. Washington, DC: National Academy Press; 2000.
- Institute of medicine report. resident duty hours: Enhancing sleep supervision and safety. December 2008.
- Horwitz L, Moin T, Krumholz H, Wang L, Bradley E. Consequences of inadequate sign-out for patient care. Arch Intern Med. 2008;168(16):1755–60. CrossRef
- Greenberg C, Regenbogen S, Studdert D, et al. Patterns of communication breakdowns resulting in injury to surgical patients. J Am Coll Surg. 2007;204(4):533–40. CrossRef
- Singh H, Thomas E, Petersen L, Studdert DM. Medical errors involving trainees: A study of closed malpractice claims from 5 insurers. Arch Intern Med. 2007;167(19):2030–6. CrossRef
- Office of the Inspector General, Department of Health and Human Services. Adverse events in hospitals: National incidence among medicare beneficiaries. https://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf. Accessed January 30, 2014.
- 2010 ACGME Residency Common Program Requirements. http://www.ama-assn.org/resources/doc/rfs/dutyhours.pdf. Accessed January 30, 2014.
- Wohlauer M, Arora V, Horwitz L, Bass E, Mahar S, Philibert I. The patient handoff: A comprehensive curricular blueprint for resident education to improve continuity of care. Acad Med. 2012;87(4):411–8. CrossRef
- Riesenberg L, Leitzsch J, Massucci J, et al. Residents’ and attending physicians’ handoffs: A systematic review of the literature. Acad Med. 2009;84(12):1775–87. CrossRef
- Farnan J, Paro J, Rodriguez R, et al. Hand-off education and evaluation: Piloting the observed simulated hand-off experience (OSHE). J Gen Intern Med. 2010;25(2):129–34. CrossRef
- Chu E, Reid M, Burden M, et al. Effectiveness of a course designed to teach handoffs to medical students. J Hosp Med Off Publ Soc Hosp Med. 2010;5(6):344–8. CrossRef
- Solet D, Norvell J, Rutan G, Frankel RM. Lost in translation: Challenges and opportunities in physician-to-physician communication during patient handoffs. Acad Med. 2005;80(12):1094–9. CrossRef
- Solet D, Norvell J, Rutan G, Frankel R. Physician-to-physician communication methods, practice and misgivings with patient handoffs. J Gen Intern Med. 2004;19(Supplement 1):108.
- Chang V, Arora V, Lev-Ari S, D’Arcy M, Keysar B. Interns overestimate the effectiveness of their hand-off communication. Pediatrics. 2010;125(3):491–6. CrossRef
- APDIM survey 2010. http://www.im.org/toolbox/surveys/APDIMSurveyData/Documents/2010_APDIM_summary_web.pdf. Updated 2011. Accessed January 30, 2014.
- Mason W, Strike PW. See one, do one, teach one—is this still how it works? A comparison of the medical and nursing professions in the teaching of practical procedures. Med Teach. 2003;25(6):664–6. CrossRef
- Horwitz L, Krumholz H, Green M, Huot SJ. Transfers of patient care between house staff on internal medicine wards: A national survey. Arch Intern Med. 2006;166(11):1173–7. CrossRef
- Arora V, Johnson J, Lovinger D, Humphrey HJ, Meltzer DO. Communication failures in patient sign-out and suggestions for improvement: A critical incident analysis. Qual Saf Health Care. 2005;14(6):401–7. CrossRef
- McSweeney M, Lightdale J, Vinci R, Moses J. Patient handoffs: Pediatric resident experiences and lessons learned. Clin Pediatr. 2011;50(1):57–63. CrossRef
- Arora V, Eastment M, Bethea E, Farnan J, Friedman E. Participation and experience of third-year medical students in handoffs: Time to sign out? J Gen Intern Med. 2013;28(8):994–8. CrossRef
- Liston B, Tartaglia K, Hupp S. Teaching handoff skills; achieving competence while maximizing faculty resources. Workshop presented at: Central Group on Educational Affairs Annual Meeting 2012 St. Louis, MO.
- Barenfanger J, Sautter R, Lang D, Collins S, Hacek D, Peterson L. Improving patient safety by repeating (read-back) telephone reports of critical information. Am J Clin Pathol. 2004;121(6):801–3. CrossRef
- Horwitz LI, Rand D, Staisiunas P, et al. Development of a handoff evaluation tool for shift-to-shift physician handoffs: The handoff CEX. J Hosp Med. 2013;8(4):191–200. CrossRef
- Handoff Practices in Undergraduate Medical Education
Journal of General Internal Medicine
Volume 29, Issue 5 , pp 765-769
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- care transitions
- medical education
- medical students
- Industry Sectors
- Author Affiliations
- 1. Division of Hospital Medicine, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
- 2. Department of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- 3. Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, PA, USA